Provider Demographics
NPI:1619263894
Name:COONEY, NATHAN CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CHRISTOPHER
Last Name:COONEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 W 1700 S STE 203
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9651
Mailing Address - Country:US
Mailing Address - Phone:801-779-6037
Mailing Address - Fax:801-820-2774
Practice Address - Street 1:1792 W 1700 S STE 203
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9651
Practice Address - Country:US
Practice Address - Phone:801-779-6037
Practice Address - Fax:801-820-2774
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80289269922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist